Wirbelfrakturen im Alter

Zusammenfassung

Wirbelfrakturen im Alter bei vorbestehender Osteoporose sind bei der immer älter werdenden Bevölkerung ein steigender Grund für Schmerzen und Einschränkungen der Lebensqualität. Es wird zwischen Wirbelfrakturen bei Osteoporose und osteoporotischen Wirbelfrakturen unterschieden. Während bei Ersterem ein adäquates Trauma für die Fraktur verantwortlich ist, ist bei Letzterem typischerweise kein Trauma erinnerlich. Die konservative Behandlung stellt weiterhin den Hauptpfeiler in der Behandlung der osteoporotischen Frakturen dar. Ist sie aber nicht erfolgreich, so kann mit Hilfe minimalinvasiver Behandlungsstrategien (Zementaugmentation mittels Vertebroplastie und Kyphoplastie) in den meisten Fällen eine Schmerzreduktion erzielt werden. Komplexe, instabile Wirbelkörperfrakturen bei Osteoporose stellen dagegen eine Herausforderung für den behandelnden Chirurgen dar. Operative Strategien zur Wiederherstellung der Stabilität trotz Osteoporose sind die Zementaugmentation der Pedikelschrauben und des frakturierten Wirbelkörpers (Hybridverfahren), aber auch aufwändige dorsale/ventrale Korrektureingriffe.

Summary

Vertebral fractures in the elderly with existing osteoporosis present an increasing reason for pain and restrictions in the quality of life, especially considering the ageing population. A distinction is made between vertebral fractures with coexisting osteoporosis and vertebral fractures due to osteoporosis. Whilst an adequate trauma is accountable for the former, the latter does not usually involve trauma. The conservative treatment is still the principle therapy for osteoporotic fractures. If, however, this form of therapy is not successful, minimally invasive treatment strategies (cement augmentation via vertebroplasty and kyphoplasty) are usually successful in achieving pain reduction in most cases. Complex, unstable vertebral fractures with existing osteoporosis, however, pose a challenge for the attending surgeon. Operative strategies in order to restore stability, despite osteoporosis, include cement augmentation of pedicle screws in addition to the fractured vertebral body (hybrid procedure), as well as extensive posterior/anterior corrective interventions.

Schlüsselwörter

Osteoporose - Wirbelsäulenchirurgie - Fraktur - Zementaugmentation

Keywords

Osteoporosis - spinal surgery - fracture - cement augmentation

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